STATEN ISLAND, N.Y. — In my article last week, we discussed the bladder and how it functions, as well as the signs and symptoms that may be associated with bladder cancer. However, other medical problems, such as urinary tract infections, non-cancerous tumors or bladder stones, can display similar symptoms. The only way to achieve a proper diagnosis is to consult with your physician who will determine whether or not your symptoms are caused by bladder cancer and, if so, the appropriate treatment for you.

If you’re experiencing signs and symptoms that may be associated with bladder cancer, see your doctor.

DIAGNOSTIC TESTS

Certain tests may help your doctor determine if you have bladder cancer, including:

Urine tests. These can check for blood in the urine and also for the presence of cancer cells.

Diagnostic imaging. This can be done with a computerized tomography (CT) scan called a CT urogram, which involves using a dye to outline the contours of the urinary tract. Depending on initial results, other types of imaging may be done, such as magnetic resonance imaging (MRI) or bone scan.

Cystoscopy. The test involves introducing a narrow, flexible, lighted instrument into the bladder through the urethra. Local anesthesia is typically used to make the procedure more comfortable. The cystoscope’s tiny camera allows your doctor to view the tissue that lines the urethra and bladder.

Removal of suspicious tissues for testing. In transurethral resection of bladder tumor (TURBT), a procedure similar to cystoscopy, a special tool is passed through the urethra to the bladder to collect a small tissue sample (biopsy), which can be examined for cancer cells. Typically, this is done under general anesthesia.

For nonmuscle invasive bladder cancer, the biopsy may prove to be both diagnostic and part of the treatment. Depending on the size of the tumor, the specialized tool may scoop out the tumor and burn away cancer with an electric current.

As with other cancers, treatment options for bladder cancer are determined by the type of cancer and how far the cancer has progressed. In some situations, it may be best to remove just the portion of the bladder (partial cystectomy) where the tumor is located by way of an open or laparoscopic surgical procedure. However, if the cancer has invaded deeper layers of the bladder wall, removal of the entire bladder and other nearby tissues is commonly done. This is called a radical cystectomy.

Another option is to attempt to save the bladder using radiation and chemotherapy treatment, followed by surgery if the disease is persistent. After bladder removal, a new urinary tract is constructed by your surgeon.

OTHER THERAPIES

Additional bladder cancer therapies that may be considered include:

Biological therapy (immunotherapy). This activates your body’s own immune cells to help fight cancer cells. Bacillus Calmette-Guerin (BCG) is the most commonly used biological therapy. It’s administered with a catheter directly into the bladder through the urethra. Immunotherapy may be done after TURBT to reduce risk of cancer recurrence.

Chemotherapy. This may be administered directly to the bladder through the urethra, or it may be directed to the entire body (systemic) through a vein in your arm. It may be used before surgery to shrink a tumor or after surgery to destroy any cancer that may remain.

Radiation therapy. This involves directing radiation at the cancer from an external machine. Radiation may be used before surgery to reduce tumor size or after surgery to kill any remaining cancer cells. This also can de done in combination with chemotherapy.

OUTCOMES

One of the keys to successful treatment of bladder cancer, as with so many other cancers, is early detection. However, early bladder cancer symptoms sometimes can be hard to distinguish from other, more common conditions. For instance, blood in the urine can also be due to a urinary tract infection or kidney disease.

What is certain with bladder cancer is the need for regular, and usually lifetime follow-ups. Recurrence remains an ongoing concern once you’ve been treated for bladder cancer.

Initial follow-ups may be needed every few months. Eventually, if your prognosis is stable, these rechecks may be reduced to once or twice yearly.

Prevention is of paramount importance, so please don’t smoke. If you do smoke, quit right now. Lead a healthy lifestyle and drink plenty of fluids and water to keep your kidneys and bladder healthy.

To your continued good health!

This column is provided by the Richmond County Medical Society. Dr. Motta is a past-president of the society and the director of Urology and Minimally Invasive Urologic Surgery at both Richmond University Medical Center and Staten Island Physician Practice. Questions may be sent to the column in care of the Advance.